Guarantee for issue of individual health plan
Individual Health Insurance
You may be working with a company that does not offer health insurance plan or you may be a self-employed. Under these circumstances you have to purchase a health insurance quote from an insurance agent.
Regulations set for individual health insurance policy are different from those applicable for job-based (group insurance) insurance plans. You have the option to choose from fee-for-service plan, HMO plan and PPO plan. Like other insurance policies individual health insurance policies also have their ‘haves’ and ‘haves not’.
Following is the illustration on this
Guarantee for issue of individual health plan: Many states have the provision to turn down individual’s application for health plan on account of individual’s health condition.
Renewal of policy Renewal of your health insurance plan can not be denied even if you fall sick.
Different states have different limits on pre-existing condition exclusions. It depends on the state where you are residing. Insurance companies may put an exclusion rider on your policy which results in total elimination of coverage for full policy life for pre-existing conditions.
Requirements of portability defers from state to state. You may not be provided with prior coverage credit and have to wait for full period of pre-existing condition exclusion.
COBRA coverage is not applicable for individual health insurance plans.
Group Health Insurance
Usually Group Health Insurance is established by employers with large number of employees. Prices of the group health insurance are negotiated based on the strength of employees. Obviously companies with greater number of employees are benefited.
In this type of insurance all participants pay premium and number of employees falling sick is considerably less. Group Health insurance contributions are shared by employee and the employer hence the employer is benefited by paying lower premium.
Some companies even allow a participant to include his spouse and dependants in the group health insurance program. Even you have the option to make your own group consisting of your family members.
This type of health insurance program is termed as family group insurance. Premiums of such group insurance health programs are comparatively low.
Usually, employers can not deny you to participate in the health insurance program. Some employers review their health insurance program on yearly basis. Many employers introduce wellness programs to ensure healthy employees and also to obtain better management of medical costs.
Like other insurance programs, group health insurance also has its disadvantages. You have very little choice to choose a health insurance plan according to your wish. Your program may restrict you to limited hospitals and doctors. Your employer may increase the premium rate depending upon the medical costs.
Medicare Health Insurance
Medicare is a federal government sponsored health insurance program. The program is aimed at providing health care services to elderly people above 65 years of age. However, age is not a bar in certain exceptions such as individuals suffering from kidney failures that requires a transplant or dialysis. Some people feel that this plan be reviewed forthwith as the cost of health care is accelerating day by day which may result in bankruptcy of this program.
Medicare plan is sub categorized in four parts covering different aspects.
Part A. This part covers only aspect of hospital insurance. It caters only for expenses on account of hospitalization or stays at nursing home. In that, you will be provided with nursing home facilities only if you have been diagnosed of the medical problem during your hospitalization or cause for nursing home stay is same that of your stay at hospital.
Part B. Coverage for doctor’s fees, medical equipments (such as walkers, wheelchairs, canes etc) and outpatient hospital care are included in this part. You have the freedom to visit a doctor or hospital of your choice or a community health center, provided that these providers are participants of Medicare program. Your benefit coverage from Medicare may change depending upon the place from where you obtain the medical treatment. In all cases, your out of pocket medical expenses will decrease gradually with Medicare.
Part C. It is an option that provides ability to Medicare beneficiaries to acquire their Medicare benefits by allowing them to obtain medical care from self chosen indemnity insurance plan or private HMO. You are allowed this in lieu of the benefits from plans under Part A & B.
Part D. This part represents the recent reforms in Medicare. These reforms are aimed at resolving the financial problems faced by the senior citizens. This part came in effect with effect from 01 Jan 2006. This part has been introduced based on the provisions of Medicare Drug.
Improvement and Modernization Act.
The basic goal of this act is to provide some fixed financial help to senior citizens for obtaining medications in the era when the medical treatments are becoming costly day by day. It is also known as prescription drug plan. A senior must enroll himself separately in this plan apart from Medicare.
These plans are maintained by private insurance companies on the subsidies received from government. Irrespective of health conditions and income any senior who is participant of Medicare can get coverage under this plan. However, coverage and plan depends upon your income, drugs you use and cost of drugs.
Medicare Supplemental Health Insurance
This is supplementary health insurance plan to cover the aspects which are not covered by other types of Medicare plans. In private insurance companies these plans are referred to as Medigap plans.
Such plans cover medical expenses like prescription coverage, expenses on preventive health care, deductibles of other types of Medicare, co-payments, extra days of hospital care (not covered under other health insurance) and even emergency care you obtained through foreign travel. List of companies that offer supplemental insurance is available on internet or you can consult an insurance provider on this aspect.
Catastrophic Health Insurance
This health care plan is also referred to as Major Medical Plan. This plan is normally offered to healthy people. You can not buy a catastrophic health insurance plan if you have major diseases such as
Multiple sclerosis
Emphysema
Heart disease
Diabetes
Schizophrenia
AIDS
Catastrophic health insurance has very low monthly premiums and high deductibles. This type of health insurance plan covers only major medical and hospital expenses.
These expenses include hospitalization charges, intensive care, laboratory tests, surgery and diagnostic tests such as X-ray. You have to for other expenses from your pocket.
You have the choice to select a catastrophic health plan providing different coverage by choosing from various deductible plans. Usually, deductible under this plan are in the range of $500 and more.
This type of health insurance is considered suitable for those who are not eligible for Medicaid and seeking for an affordable health insurance plan.
